OBJECTIVE: Primary human cerebral myiasis is an exceedingly rare condition and is almost never encountered by physicians in developed countries. The case report summarizes a case of extensive cerebral myiasis in a periurban community in the United States.

CLINICAL PRESENTATION: After a minor motor vehicle accident, police brought a 75-year-old man to the emergency room because he was observed to have a large cranial lesion. Examination revealed a 15 x 17 cm frontal bone defect with eroded frontal dura, exposed cortex, and massive cortical maggot infestation.

INTERVENTION: The patient was empirically treated with intravenous antibiotics for meningitis. Maggots (Phaenicia sericata, or the green bottle fly) were removed by suction, attrition, and gentle contact exposure to a mild bleach solution. Biopsy of the scalp and cranium revealed angiosarcoma, for which operative treatment was refused. The patient was transferred to a skilled nursing facility for palliative care where he died 3 months later.

CONCLUSION: This is the first published case of cerebral myiasis in the United States. Although human cerebral myiasis is rare, conditions do exist in this country that permit myiasis."

OBJECTIVE: Only eight cases of cerebral myiasis in humans have been reported worldwide and only one in the United States. Presented here is a case of cerebral myiasis in the setting of head trauma in suburban Los Angeles.

METHODS: The article includes chart review and description of a clinical case presentation.

RESULTS: A 42-year-old HIV-positive man was found in a ditch after 2 weeks, the victim of apparent assault. He had multiple facial fractures along with open depressed bifrontal sinus fractures with necrotic bone, eroded dura, exposed cortex, and extensive maggot infestation of the left frontal lobe.

The patient was taken urgently to the operating room, where the maggots where evacuated by irrigation and suction. Debridement of necrotic bone, dura, and brain was performed, the frontal sinuses were exenterated, and skull defects plated with titanium mesh. Intraoperative cultures revealed a polymicrobial meningitis/encephalitis, which was treated postoperatively with antibiotics.

The patient's neurologic exam stabilized and the patient was transferred to a rehabilitation facility for further care, ultimately achieving functionality and holding a job.

CONCLUSION: This is the first published case of cerebral myiasis secondary to trauma, and to our knowledge, the first documented long-term survivor of extensive cerebral myiasis. Wide debridement to normal brain followed by 6 weeks of broad-spectrum antibiotic treatment is effective in managing this condition. A well-functioning outcome can be expected with prompt recognition and treatment of the disease. Larval infestation may have a protective effect against bacterial infection and may allow for greater tolerance of treatment delay.

After a minor motor vehicle accident, police brought a 75-year-old man to the emergency room because he was observed to have a large cranial lesion.

Apparently this is NOT the result of the motor vehicle accident. The police on the scene took him to the hospital after observing that the man had a large lesion (not a wound) on his head. Basically, for reasons not specified, he's had his cranium cut open and it was left untreated for some time, resulting in infection and bot fly larvae infestation.